The advantages of adding rib fixations during VATS for retained hemothorax in serious blunt chest trauma - A prospective cohort study

Background: Serious blunt chest trauma usually induces hemothorax, pneumothorax, and rib fracture. Early video-assisted thoracoscopic surgery (VATS) to evacuate retained hemothorax is one commonly used treatment. In this study, a new strategy was implemented to combine VATS with fractured rib fixation simultaneously. Methods: This prospective observational study was performed from January 2013 to April 2018. All patients were aged 18 years or older and had blunt chest trauma with displaced fractures in more than three ribs. No patients had acute respiratory failure within 24 h after trauma. Patients with retained hemothorax who received VATS constituted the study cohort. Subsequently, patients who received rib fixation during VATS procedures were compared with those who did not. Clinical outcomes such as dose of analgesics, and length of hospital stay were recorded. Results: During the study period, 128 patients were enrolled. Available demographic characteristics of the 2 groups were compared, and no statistical differences were observed. The rates of shorter temporary ventilator dependence after operations were lower in the rib fixation group (0% vs. 24.7%, P= 0.017). Persistent air leakage more than 5 days after operations were also lower in the rib fixation group (0% vs. 10.4%, P= 0.001). The length of stay in overall hospital stay were longer for patients who received VATS without rib fixation (9.29 +/- 2.51 days vs. 12.39 +/- 4.65, P= 0.001). Furthermore, the rib fixation group were administered much lower doses of opiates during their hospital stays (52.45 +/- 15.67 mg vs. 77.24 +/- 50.42 mg, P= 0.001). Conclusion: Adding rib fixation during VATS in the management of retained hemothorax can contribute to shorten whole treatment courses. Rib fixation can also reduce pain, thus reducing dependence on analgesics.